Healthcare Provider Details

I. General information

NPI: 1609005461
Provider Name (Legal Business Name): ANITA PRAKASH VIN-PARIKH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA P VIN MD

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 03/07/2023
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 EXECUTIVE DR
RALEIGH NC
27609-7445
US

IV. Provider business mailing address

3320 EXECUTIVE DR
RALEIGH NC
27609-7445
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-2427
  • Fax: 919-850-9234
Mailing address:
  • Phone: 919-876-2427
  • Fax: 919-850-9234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number2013-00412
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2013-00412
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: